Consultation Letter (Pediatric Cardiology)

Letter Date: [Date]

To: [Referring clinician name, credentials, and practice]

Patient: [Full name], DOB: [DOB], MRN: [MRN]

Date of Service: [Consultation date]

Location: [clinic / inpatient / ED / telehealth]

Re: [Referral reason]

Dear Dr. [Referring clinician last name],

Thank you for referring [patient name] for evaluation on [consultation date] regarding [referral reason]. [Restated specific referral question, if posed]

Impression & Recommendations

• Impression / Diagnoses
  • [Primary diagnosis answering the referral question]
  • [Additional diagnosis] (Include only if directly assessed.)
  • [Severity, risk stratification, or functional status] (Include only if clinically meaningful.)
• Key Supporting Findings
  • [Pertinent exam or test finding supporting the impression]
  • [Pertinent exam or test finding supporting the impression]
  • [Additional finding] (Include only if material to the assessment.)
• Recommendations
  • [Action item] — [Owner: cardiology / PCP / family] — [Timeframe]
  • Activity/sports: [cleared without restriction / cleared with restrictions / not cleared pending further evaluation] (State conditions or duration if applicable.)
  • Endocarditis prophylaxis: [indicated / not indicated] (Include only when relevant to the diagnosis.)
  • Follow-up: [interval or PRN; specify who will schedule]
  • Return precautions: [symptoms that should prompt earlier contact]

Urgent/critical communication: [Who was contacted, method, date/time, and summary] (Include only if urgent or critical results were communicated directly.)

Clinical Summary

[History of present illness] (Concise narrative: onset, duration, frequency, triggers, context, associated symptoms, and pertinent negatives relevant to the referral.)

[Pertinent past cardiac history, relevant comorbidities, current cardiac medications, allergies] (Summarize only information that informs the assessment.)

[Family history of congenital heart disease, arrhythmia, cardiomyopathy, or sudden death] (If unknown and clinically important, state "unknown.")

[Social history] (Sports participation, activity level, and lifestyle factors relevant to cardiac risk.)

Examination

• [Vitals: HR, BP with percentiles if relevant, RR, SpO2; growth parameters with percentiles]
• [Cardiovascular: heart sounds, murmur characterization if present, pulses, perfusion]
• [Other pertinent findings] (Include only if they affect the assessment.)

Diagnostic Studies (Note whether performed today or reviewed from outside records; state any limitations.)

• [ECG: rate, rhythm, intervals, axis, notable findings]
• [Echocardiogram: structure, ventricular function, valvular function, key measurements]
• [Other studies: Holter, stress test, imaging, labs] (Include only completed studies with results.)

Closing

Please contact me with any questions or if new symptoms arise.

Sincerely,

[Consulting clinician name], [Credentials]
Pediatric Cardiology
[Institution]
[Phone] | [Fax] | [Secure message/portal]

(Omit sections or bullets not relevant to this consultation. When clinically important information is unavailable, state that it is unknown rather than leaving blank.)